Massage and Me
Pre-Treatment Consultation Form (Existing Clients)

Thank you so much for booking in again with Massage and Me,
I’m so excited to see you soon!

Please complete the following consultation form with me below:

Relaxation Awaits…

Personal Information

First Name

Last Name

Email

Confirmation of treatment, including date and time

Will you require a parking permit while at your appointment?

Yes please

No thank you

IF YES - please confirm your car registration number

Would you like me to wear a mask during your treatment?

Yes

No

Medical Conditions: Any change in health conditions since your last treatment?

Yes

No

If YES - please explain further

Personalising Your Treatment

What is the main reason for your visit? Is there anything else I should know before your treatment - e.g: How would you like to feel after your treatment, your main areas of tension, the sort of pressure you like

Declaration and Consent

Please confirm you agree with the following statement: The information I have provided is correct. I have not withheld any personal or medical information that may affect my treatment. I will adhere to the Massage and Me safety and hygiene guidelines before and during my treatment. I will not hold my therapist, Jo Murch or Massage and Me responsible should I, members of my family or friends become unwell following my holistic therapy treatment. This form will be kept on file securely by Jo at Massage and Me, and will not be shared with any third parties.

I agree

I do not wish to continue

For my Autistic Clients:

Please follow the link below for my webpage entitled ‘What to expect from your Massage and Me Treatment’ that may help you before you arrive. Please ask me at any point, whether pre-appointment or during your treatment, any questions you may have, or for me to alter something that might help you to enjoy your treatment more. My job is to make you comfortable.

WHAT TO EXPECT FROM YOUR MASSAGE AND ME TREATMENT

Extra Information Required from Pregnant Clients Only:

Please state your due date and how many weeks pregnant you'll be at your appointment

Please list any recent symptoms or side effects of your pregnancy

Optional Extra Notes Section

Would you like Jo to massage your bump?

Yes please

No thank you

I'll have a think and let you know on the day

Please confirm your name and today's date

Massage and Me
Pre-Treatment Consultation Form (Existing Clients)

Thank you so much for booking in again with Massage and Me,
I’m so excited to see you soon!

Please complete the following consultation form with me below:

Relaxation Awaits…

For my Autistic Clients:

Extra Information Required from Pregnant Clients Only:

Thank you so much. Please don’t hesitate to contact me if you have any questions or concerns.

Now for the excitement of looking forward to your appointment!

Take care and see you soon,
Jo

Who's Jo? Learn more here

Massage and Me Pre-Treatment Consultation Form (Existing Clients)

Thank you so much for booking in again with Massage and Me, I’m so excited to see you soon!

Please complete the following consultation form with me below:

Relaxation Awaits…

For my Autistic Clients:

Extra Information Required from Pregnant Clients Only:

Thank you so much. Please don’t hesitate to contact me if you have any questions or concerns.

Now for the excitement of looking forward to your appointment!

Take care and see you soon, Jo

Massage and Me
Pre-Treatment Consultation Form (Existing Clients)

Thank you so much for booking in again with Massage and Me,
I’m so excited to see you soon!

Take care and see you soon,
Jo